Managed Care Specialist

6 days ago


Los Angeles, California, United States Insight Global Full time

Company Overview

At Insight Global, we are committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. As an equal opportunity/affirmative action employer, we believe everyone matters.

Job Description

We are seeking a highly organized and detail-oriented Managed Care Specialist to join our team. In this role, you will support the Appeals and Grievances team in receiving, investigating, and resolving member and provider complaints and appeals. Your primary function will be to learn specialty-level appeals and grievances work by resolving less complex cases to ensure positive outcomes for members.

Key Responsibilities

  • Intake and acknowledge complaints, prepare case files, and route them to appropriate internal departments and external business partners for investigation and resolution
  • Process assigned cases accurately and in a timely manner per instructions, escalating complex issues or questions to leadership as needed
  • Actively participate in team meetings and provide recommendations for improvement based on discoveries

Required Skills and Qualifications

  • At least 1 year of experience in Managed Care working with Medicare, Medi-Cal, and other State Sponsored programs
  • Strong advocacy experience and ability to exercise strong independent judgment
  • Ability to interpret and apply regulations, work with firm deadlines, and resolve conflicts

Benefits

We offer a competitive salary range of $26-$33 per hour, depending on experience. Additionally, we provide a supportive and inclusive work environment where you can grow and develop your skills.

Estimated Salary: $54,240 - $67,920 per year



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